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Community Care

Volume 175: debated on Tuesday 3 July 1990

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12.

To ask the Secretary of State for Health what representations have been received from local authorities regarding the costs of implementing the Government's proposals on community care.

We are having discussions with local authority associations in the usual way. The local authorities have produced an estimate of those costs which they believe will be necessary in the implementation of care in the community.

Does the Minister agree that the Government appear to be having extreme difficulty understanding the argument? It is not a question of centralising power; it is one of a shortfall in finances. Does the Minister agree that by 1994 social services depts will be facing a shortfall of £500 million? The projections are that the fall in Government funding and increasing costs will mean that the social services departments will have the greatest difficulty implementing the Children Act 1989 and care in the community. What do the Government propose to do about it?

The hon. Gentleman is right that local authority social services departments are already implementing the Children Act as well as carrying forward plans for care in the community. Social services departments have seen an increase in their spending of about 37 per cent. over the past 10 years. Of course, they will have to seek good value for money and meet the most important priorities in carrying forward their plans. We have always made it clear that adequate resources will be made available for implementing care in the community.

How can my hon. Friend assure the House that there will be adequate funds for community care after April 1991, bearing in mind the fact that it is almost inevitable—I have it from the highest level of government—that there will be additional capping next year? How can my hon. Friend and my right hon. and learned Friend the Secretary of State guarantee the House that the most vulnerable groups of people—the mentally handicapped, the mentally ill, the elderly and the disabled—will get the sums of money that are allocated to them under the present system when capping will take a major part of next year's local government financial allocation?

There were those who believed that local authorities should not be entrusted with the important task of care in the community. I am not one of those people. Had the health service undertaken that responsibility, it would have become a directly managed service. Local authority responsibility involves local accountability. Where a particular need has to be addressed, a limited specific grant is appropriate, and for that reason last week my right hon. and learned Friend the Secretary of State introduced the popular ring-fenced grant for drug and alcohol-related difficulties. We have made it clear throughout that adequate resources will be made available for the implementation of care in the community.

Does not the Minister appreciate that in addition to the problems faced by local authorities, as outlined by the hon. Member for Macclesfield (Mr. Winterton), the health authorities are offloading people into the community far more rapidly than was ever envisaged when care in the community gained all-party support? They are forced by the squeeze on their budgets to release property on to the open market or to release patients back into the community without adequate back-up care. When will the Minister make sure that one arm of government is working in conjunction and harmony with other arms of government so that people do not fall through the net? That is precisely what is happening at the moment.

I do not underestimate the difficulty of implementing care in the community. It will take 10 years to achieve the care for the frail and vulnerable that many of us hope to see. One such difficulty is not the narrow question of resources that my hon. Friend the Member for Macclesfield (Mr. Winterton) mentioned. The key is persuading the different groups to collaborate and to plan together to ensure that those who require the help receive it. My right hon. and learned Friend the Secretary of State spoke of the increase in resources to the health service. I have made it clear that there has been a substantial increase in funding to local authority social services departments, quite apart from the vast resources that are given through social security. The key is to make those substantial resources work effectively in the best interests of the frail and vulnerable.

When my hon. Friend responds to representations from local authorities, will she resist the pressures to support ring fencing of budgets? Does she agree that hon. Members who support wholesale ring fencing of local government budgets are in favour of destroying local government as we know it?

I entirely endorse my hon. Friend's point. Ring fencing of substantial sums of money undermines local accountability. Those who believe in local government should welcome local accountability. Plans will have to be made for community care. My right hon. and learned Friend the Secretary of State will have powers of direction and there will be appropriate safeguards.

What advice on the cost of community care did the Minister and her colleagues give the Secretary of State for the Environment before he capped 19 social services authorities? Is she aware that in the past month, as a result of that capping, North Tyneside has had to cut its social services budget by a tenth, Derbyshire by £2.5 million, and Fulham by £1.5 million and that Barnsley is having to shut old folks' homes and introduce charges for home helps of £5 a week? Is not she concerned about the effect of those sharp cuts and savage rises on elderly and disabled people in our community? What is the point of her lecturing local authorities to provide more community care when her colleagues in the Government penalise the local authorities that provide the most?

The hon. Gentleman constantly identifies with the producer interest rather than with those who must pay the community charge. I am well aware that elderly and disabled people and others must pay the community charge. They welcome the fact that they have been protected from the excessive spending of their local authorities by my right hon. Friend the Secretary of State for the Environment. It is right for local authorities to make proper plans, but that does not involve spending £1 million on a publicity department for Derbyshire county council.